NPIMap

Organization Active NPI

Southern Illinois Healthcare Foundation Inc

Doing business as SIHF Healthcare

  • Federally Qualified Health Center (FQHC)
  • Waterloo, IL
National Provider Identifier
1821813247
Registry record updated Nov 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC
Doing business as
SIHF Healthcare
Practice address
509 Hamacher St Ste 201
Waterloo, IL 62298-1592
Phone
(618) 332-0953
NPI assigned
Nov 20, 2024
Last updated
Nov 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Larry McCulley
Title
Ceo
Phone
(618) 332-0694

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Cardiology Physician 207RI0011X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

509 Hamacher St Ste 201
Waterloo, IL 62298-1592

Mailing address

2041 Goose Lake Rd
Sauget, IL 62206-2822
Phone (618) 332-0953

Other names 2

  • SIHF Healthcare Doing business as
  • SIHF Healthcare - Waterloo Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031126000641 IL Part B Supplier - Clinic/Group Practice 1456256874 Receives reassigned benefits from 170 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: East Saint Louis, IL; Effingham, IL; Fairmont City, IL; Glen Carbon, IL; Granite City, IL; Greenup, IL; Mattoon, IL; Millstadt, IL…
O20241207000017 IL Part A Provider - Federally Qualified Health Center (FQHC) 1456256874 Practice locations: Waterloo, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821813247. Details of each certification follow.

Federally qualified health center certification: CCN C41041

Legal name
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC
Doing business as
SIHF HEALTHCARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 16, 2024
Last certification
Dec 16, 2024
Ownership / control type
Non-profit – other
Organization structure
CorporationNon-profit
Enrollment address
509 Hamacher St
Ste 201
Waterloo, IL 62298-1592

National Provider Directory

National Provider Directory
Tax ID family
Southern Illinois Healthcare Foundation Inc38 organizations share this tax ID, including this one

Other organizations with this tax ID 37

Organizations that report the same tax identification number in the National Provider Directory.

View all 37

Locations

2 Memorial Dr
Ste 122
Alton, IL 62002
Phone (618) 462-6612

12 N 64th St
Ste 7
Belleville, IL 62223
Phone (618) 398-9850

2810 Frank Scott Pkwy W
Ste 828
Belleville, IL 62223
Phone (618) 236-6336

2900 Frank Scott Pkwy W
Ste 950
Belleville, IL 62223
Phone (618) 233-3205

7210 W Main St
Ste 102
Belleville, IL 62223
Phone (618) 394-0712

626 W Lincoln Ave
Charleston, IL 61920
Phone (217) 345-7702

1215 Vandalia St
Collinsville, IL 62234
Phone (618) 343-6015

9649 Collinsville Rd
Collinsville, IL 62234
Phone (618) 578-5701

131 N Bellwood Dr
East Alton, IL 62024
Phone (618) 259-0354

2 Terminal Dr
Ste 4B
East Alton, IL 62024
Phone (618) 216-8127

100 N 8th St
#124
East Saint Louis, IL 62201
Phone (618) 482-7100

2057 Edison Ave
Ste A
Granite City, IL 62040
Phone (618) 451-2145

1425 6th St
Madison, IL 62060
Phone (618) 877-7086

1510 Sunset Dr
Vandalia, IL 62471
Phone (618) 283-3144

727 W Jackson St
Vandalia, IL 62471
Phone (618) 283-3144

5540 Bunkum Rd
Washington Pk, IL 62204
Phone (618) 875-4701

509 Hamacher St
Ste 201
Waterloo, IL 62298
Phone (618) 216-8127

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Walter Hunter Individual Corporate Director Dec 16, 2024
Gerard Hasenstab Individual Corporate Director Dec 16, 2024
Dale Fiedler Individual Corporate Director Dec 16, 2024
Debra Reed Individual Corporate Director Dec 16, 2024
James F Spinner Individual W-2 Managing Employee Dec 16, 2024
Larry W McCulley Individual Corporate OfficerCeo Dec 16, 2024
Kenneth Hall Individual Corporate Director Dec 16, 2024
Zoila Marty Individual Corporate Director Dec 16, 2024
Ethel Manager Individual Corporate Director Dec 16, 2024
Anna Marie Nelson Individual Corporate Director Dec 16, 2024
Richard Sinclair Individual Corporate Director Dec 16, 2024
Irma Golliday Individual Corporate Director Dec 16, 2024

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Touchette Regional Hospital IncCahokia Heights, IL, CCN 140077 Hospital Operational/Managerial Control Jun 30, 2009
Touchette Regional Hospital IncCahokia Heights, IL, CCN 14S077 Hospital Operational/Managerial Control Jun 30, 2009

Practitioners & affiliated clinicians

Practitioners 167

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 167

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1732060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732060800000",
    "number": "1821813247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2041 GOOSE LAKE RD",
            "city": "SAUGET",
            "state": "IL",
            "postal_code": "622062822",
            "telephone_number": "618-332-0953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 HAMACHER ST STE 201",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981592",
            "telephone_number": "618-332-0953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-20",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A",
        "authorized_official_last_name": "MCCULLEY",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "618-332-0694"
    },
    "taxonomies": [
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SIHF Healthcare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SIHF Healthcare - Waterloo",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Waterloo, IL

Sources for this page

Verify at the official NPI Registry.